Yale doctor's mindfulness training helping smokers

NEW HAVEN, Conn.—A Yale doctor's research into a technique called mindfulness training and how it can help smokers quit is now available as an app.

Craving to Quit, an app for iPad or iPhone, was developed by goBlue Labs, based at 5 Science Park. The company was founded by Dr. Judson Brewer, medical director of the Yale Therapeutic Neuroscience Clinic.

Mindfulness, a technique rooted in Buddhism and other traditions, proved effective in a smoking-cessation study Brewer conducted in 2009.

In Brewer's four-week study, 88 smokers with an average age of 46, smoking a pack a day, used either mindfulness training or the American Lung Association's Freedom From Smoking program.

At the end of treatment, 36 percent of the group that learned mindfulness training had quit versus 15 percent using FFS. After 17 weeks, the success rate was 31 percent vs. 6 percent. The results were published online in July 2011 in the journal Drug and Alcohol Dependence.

The app, developed from Brewer's research, is a three-week, self-directed program that teaches users how to become more aware of themselves and their environment in the moment, and to apply that to the act of smoking and its effects. It is "a pretty accurate translation of the manualized program that Jud delivered live in groups," said Socheata Poeuv, CEO of goBlue Labs.

Learning mindfulness is difficult, because the brain resists it.

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While practicing the technique, you are simply noticing the world from a detached point of view, not pushing thoughts away or dwelling on them, but letting them pass through. The narrator on the app, which sells for $49.99 in the Apple App Store, quotes Jon Kabat-Zinn, as saying, "Mindfulness is paying attention in a particular way, on purpose, in the present moment and non-judgmentally."

Brewer calls it "getting out of their own way."

When practicing mindfulness on a craving, "It's a very physical experience," said Mahri Leonard-Fleckman, an expert in mindfulness and, incidentally, Brewer's fiancée. "You experience it in your body, usually in your gut. . It's sort of a subtle clenching in the gut."

Michelle Morgan, 33, of New Haven, quit smoking Jan. 20, 2011, as part of Brewer's study. She had been a pack-a-day smoker for 20 years.

"It made me a little emotional for a while," she said of the mindfulness techniques. "I found myself wanting to connect with people in a different way" because she was so present in the moment.

"You actually have to face the cravings and deal with them instead of ignoring or wishing them away," Morgan said of the technique, which she said she rarely practices now. "You just kind of have to accept that it's there and wrangle with it a little bit."

The trick is to feel the craving but not to pay attention to it, so that it dies out on its own. One animation in the Craving to Quit app shows a toddler, who represents a craving, screaming for a lollipop. Rather than trying to stop the toddler from crying, or mollifying him with a lollipop, the trick is to let the toddler scream himself out, until he stops.

Leonard-Fleckman said that once you understand what the craving is, if you're "stuck on something or trapped in a thought, it's like holding a hot coal." As the narrator in the app explains, you naturally drop a hot coal because it's burning you, and you begin to realize that smoking is like that hot coal, causing pain while giving nothing positive in return. "Having a craving to smoke is another subtle form of suffering," she said.

On the other hand, true mindfulness is "just a very open feeling. It's peaceful . Your mind's not wandering if you're just being there watching the world then that is a form of meditation," said Leonard-Fleckman.

Each day of Craving to Quit offers tips on breaking the "habit loop" that cravings cause, doing a body scan to notice how your body feels and using techniques like RAIN: recognize the craving, accept it, investigate it from a detached place and noting the experience until the craving, coming in like it's riding a surfboard, crashes on the beach.

There's even an exercise in which the smoker focuses on the act in a mindful way: "Hold it in your hand, feel the texture the weight of the cigarette. Look closely at all of the paper, the colors, the speckles, the tobacco on one end and the filter on the other. Smell the cigarette. What does it smell like?"

At the end, the narrator asks, "Is this how you normally smoke a cigarette? . When you really start paying attention to what you're doing, you can see much more clearly what you're actually getting from it. It might not be as good as you think it is."

Brewer said the method doesn't "rub it in their face. . They have to actually see what they're getting. . It's harder for them to deny what they're doing. It's harder for them to delude themselves."

Brewer has begun to use neuro-feedback to see how mindfulness affects the brain. He can see how a region of the brain, the posterior cingulate cortex, is activated by cravings and how it quiets when the craving leaves.

So far, goBlue Labs has sold the app to individuals, but Poeuv said the goal is large customers, such as corporate wellness programs, hospitals and health insurance companies. "Yale Health will probably be our first customer," she said.

Brewer and Poeuv see a growing market for smoking-cessation programs once the Affordable Care Act is fully implemented next year.

Companies will be allowed to charge smokers more for health insurance, as much as 50 percent more, but must offer cessation programs as well.

"By 2014 companies are going to be scrambling to find affordable, effective smoking solutions because they have to offer them if they're going to be charging more for their insurance," Brewer said.

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